While filming at the Personalized Medicine World Conference in Mountain View recently, I had a chance to catch up with George Lundberg, MD, former JAMA Editor in Chief of JAMA, current Editor-at-Large of Medscape, and now Chief Medical Officer and Editor-in-Chief of CollabRx. CollabRx is a publicly-traded for-profit San Francisco-based data analytics company that does applied oncogenomics.

Oncogenomics and precision medicine

Cancer Cells | Source: The Telegraph

Oncogenomics is a relatively new field of medicine that systematically tries to identify specific genes that are involved with initiation and progression of cancer, thereby allowing the development of targeted (precision or personalized) cancer treatment.

George points out that,

“Cancer is a disease of genomes. We know that mutations often drive cancers and these mutations are in the primary [tumor] or sometimes, when there is a metastatsis, it is another different mutation or sets of mutations. Some of these mutations are naturally occurring because sometimes mutations happen during cell division. But many mutations occur because of environmental influences: tobacco being number one, the sun probably being second. But, there are many others as well.”

There are diagnostic tests that can help identify exactly what these mutations and there are targeted therapies that actually work for some of the cancers (e.g., Gleevec, Herceptin, and Avastin). Unfortunately, George says, “there are not a lot of them yet, but there are hundreds being tested and a huge literature has developed.”

What does CollabRx do?

According to George, his company “deals with molecular changes in cancers and tries to help doctors [find] the best targeted therapies for patients with advanced cancers or cancers that are capable of becoming advanced.”

CollabRx has two main products—one is for oncologist and patients and one is primarily for laboratories. The first product, CancerRx, is a therapy finder to guide decision-making, using algorithmic decision trees, for patients with metastatic cancer (breast, colorectal, lung, and melanoma). They developed these decision trees based upon the models that George points out were first published in JAMA beginning in 1975. At that time, scientists drew models of how to go from a laboratory result to action using paper and pen (remember that?).

But now, with computers, rather than having branching logic on a piece of paper, the doctors can enter information into a computerized form, click a button and let the computer work through the encoded decision tree to figure out “what is the best information available to handle the most difficult patients who have advanced cancers with the most information that is up-to-date.”

According to George, CollabRx algorithms are “informed by the world literature and by our own editorial boards of which we have about 75 members advising us.”CancerRx is a free app on the App Store for people with apple products. Android users can find the same information in the web app at www.collabrx.com (click on the Therapy Finder link under ‘View the Technology’).

CollabRx’s other product is Genetic Variant Annotation (GVA) service that is available for laboratories that do diagnostic tests on cancers to determine their genomic information. The lab’s computers can then talk to the CollabRx computers to determine the best course of action for each individual patient.

George says, “The field of precision medicine is booming. The conference we are, Personalized Medicine World Conference, started 9 years ago with 30 people. This year, there were over a thousand and some people had to be turned away. The conference was sold out. The field is booming. There’s hype, there’s hope, a little bit of both, but very vibrant science.”

Patricia Salber, MD, MBA is the Founder and Editor-in-Chief of The Doctor Weighs In. She is also a physician executive who has worked in all aspects of healthcare including practicing emergency physician, health plan executive, consultant to employers, CMS, and other organizations. She is a Board Certified Internist and Emergency Physician who loves to write about just about anything that has to do with healthcare.

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